Organization
RICHARD GAINES, PH.D., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD WILLIAM GAINES PH.D. (OWNER)
(201) 444-9866
Entity
Organization
Contact information
Practice address
88 W RIDGEWOOD AVE, RIDGEWOOD, NJ 07450-3199
(201) 444-9866
Mailing address
140 DEER TRL N, RAMSEY, NJ 07446-2113
(201) 314-0515
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
3956
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
061718
MEDICARE PTAN
NJ
Enumeration date
05/03/2012
Last updated
06/06/2012
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